International Adoption

Prospective parents adopting a child from overseas need information to safeguard the health of the child. This webpage contains information for adopting parents, adoption service providers, and health care providers.

The U.S. Department of State records show that from October 1, 2018 to September 30, 2019, a total of 2,971 children who have been adopted from other countries immigrated to the United States. The largest numbers of these children were originally from mainland China (819), Colombia (244), India (241), South Korea (166), and Ukraine (298). The risk for lead exposure is much higher in many countries from which children are adopted than in the United States (1, 2, 3). Each country sets its own policies on regulations for environmental exposures, and some countries have stronger regulations than others.

Main sources of exposure to lead differ from country to country
Children’s exposure to sources of lead varies by country (1, 2, 3). Even within a country, lead exposure may vary by racial/ethnic group or income level. In the United States, lead-based paint and lead-contaminated dust and soil are the primary sources of childhood-lead exposure.

Children from outside the United States can be exposed to lead from

  • Ceramic or metal dishes or pots used for cooking or eating,
  • Contamination from living with a person who is exposed on the job,
  • Contamination from nearby mining and smelting,
  • Cosmetics,
  • Cottage industries (e.g., breaking up batteries or metal ore),
  • Drinking water from metal pipes or metal storage containers,
  • Food, spices, and candies (from the ingredients or the packaging),
  • Industrial emissions, and
  • Traditional medicines

Risk for lead poisoning
No safe blood lead level for children has been identified. Because lead exposure often occurs with no obvious symptoms, it frequently goes unrecognized. In 2021, the Centers for Disease Control and Prevention (CDC) adopted use of the blood lead reference value (BLRV) of 3.5 μg/dL or higher based on recommendations from CDC’s federal advisory committee made up of experts in the field. The CDC BLRV is based on the U.S. population of children ages 1-5 years who represent those at the top 2.5% with the highest blood lead levels. Evidence exists that lead in the body, even at low levels, can cause health problems and affect a child’s behavior or how they learn in school (4, 5). At very high levels, in extreme cases, it can cause seizures or death.

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Parents or Prospective Parents of Children who have been Adopted

Why should I be concerned?
Concern exists about children adopted from overseas who may have been exposed to lead before they came to the United States. Recently in the United States, a small number of children who have been adopted from other countries have been found to have high levels of lead in their bodies.

As a group, children who have been adopted from other countries tend to have higher levels of lead in their blood than children born in the United States (3). Children can be exposed to lead in different ways in countries (1, 2, 3).

How do I know if my child was exposed to lead?
Most children with lead in their blood do not have any symptoms. The only way to know for sure is to have your child tested with a blood test.

How can I check for lead in my child?
Ask your child’s doctor to test your child for lead in their blood. You may want to contact your state or local Childhood Lead Poisoning Prevention Program.

Who can I contact for blood lead testing or other information about the health of my child who has been adopted from another country?
You can contact either your doctor or your local health department if you have concerns about lead in your child’s blood or other health concerns.

The American Academy of Pediatrics provides recommendations on comprehensive health evaluations for all children who have been newly adopted.external icon
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Intercountry Adoption Service Providers

Adoption service providers play an important role in increasing awareness of lead exposure among children who have been adopted from other countries. Under current regulations and routine practice, blood lead levels among foreign-born children may not be detected.

Adopting parents lack information on the hazards of lead exposure that could help them improve their children’s growth, development, and prospects for the future.

It is important that adoption service providers provide lead-exposure fact sheets with health information, including information on accessible testing sites, to prospective parents.

Adoption service providers should also encourage adopting parents and doctors to test foreign-born children for lead exposure when they arrive in the United States.

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Health Care Providers

International Childhood Lead Exposure
Children immigrating to the United States through intercountry adoptions have health issues as diverse as the cultures into which they were born (6, 7). Although recent research is sparse, evidence suggests that a significant proportion of immigrant children and children who have been adopted from other countries have been exposed to lead. Risk for lead exposure varies by country of origin (1, 2, 3). According to one study, 40% of children from Cuba and Haiti, 37% from Asia, 27% from Vietnam and Africa, and 25% from the Near East had blood lead levels. Overall, approximately 11.3% of children who have been adopted from other countries have blood lead levels ≥10 micrograms per deciliter (1).

Medical Testing before Immigration to United States
Blood lead testing is not required before immigration to the United States. Before arrival in the United States, all immigrants are required to have a medical examination in their country of origin by a physician approved by the local U.S. embassy or consulate. This medical examination focuses primarily on detecting serious disabilities and contagious diseases.

Screening and Medical Management Recommendations
Screening for blood lead level is recommended upon arrival to the United States and at 12 and 24 months of age. Physicians should follow their state and local guidelines on health screening of children living in conditions that place them at a high risk for lead exposure. Children who have been adopted from other countries are considered high risk for lead exposure (6, 7, 8). You can also contact the Childhood Lead Poisoning Prevention Program in your state for additional information.

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Video: ‘Lead Poisoning Prevention among Children who have been Adopted from Other Countries’

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Educational Materials

Educational materials for download
Dr. Hoot N. Owl Bookmark
Dr. Hoot N. Owl Bookmark pdf icon[PDF – 695 KB]
Print this image and cut out at margins as a reminder to do a lead test on children who have been adopted from other countries.
Leadbert the Licensed Contractor Bookmark
Leadbert the Licensed Contractor Bookmark pdf icon[PDF – 915 KB]
Print this image and cut out at margins and keep as a reference to information on lead poisoning prevention.

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Additional Resources

Intercountry Adoption Health Guidance
Information for parents, adoption providers, and clinicians about intercountry adoption.

Child Welfare Information Gateway: Intercountry Adoptionexternal icon
The Child Welfare Information Gateway is a service of the Children’s Bureau, Administration for Children and Families, U.S. Department of Health and Human Services.

U.S. Department of State: Intercountry Adoptionexternal icon
This site provides information and guidance to U.S. citizens seeking information about intercountry adoptions.

U.S. Citizenship and Immigration Services pdf icon[PDF – 1.36 MB]external icon
This site provides information on intercountry adoptions and the immigration process.

Joint Council on International Children’s Services (JCICS)external icon
JCICS is a nonprofit intercountry adoption organization that works to promote ethical practices in intercountry adoption. This site provides information relevant to intercountry adoption service providers, community-based organizations, parent support groups, and medical clinics.

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(1) CDC. Elevated blood lead levels among internationally adopted children – United States, 1998. MMWR. 2000;49(5):97-100.

(2) Geltman PL, Brown MJ, Cochran J. Lead poisoning among refugee children resettled in Massachusetts, 1995 to 1999. Pediatrics. 2001;108(1):158-162.

(3) Parisa T, Leighton J, Auchincloss AH, Faciano A, Alper H, Paykin A, et al. Immigration and risk of childhood lead poisoning: findings from a case–control study of New York City children. Am J Public Health. 2008;98(1):92-97

(4) CDC. Childhood Lead Poisoning Prevention Program (

(5) Canfield RL, Henderson CR, Cory-Slechta DA, Cox C, Jusko TA, Lanphear BP. Intellectual impairment in children with blood lead concentrations below 10 µg per deciliter. N Engl J Med. 2003;348:1517–1526.

(6) Hellerstedt WL, Madsen NJ, Gunnar MR, Grotevant HD, Lee RM, Johnson DE. The international adoption project: population-based surveillance of Minnesota parents who adopted children internationally. Matern Child Health J. 2008;12(2):162-171.

(7) Jenista JA. The immigrant, refugee, or internationally adopted child. Pediatr Rev. 2001;22(12):419-429.

(8) CDC. Recommendations for blood lead screening of Medicaid-eligible children aged 1–5 years: an updated approach to targeting a group at high risk. MMWR. 2009;58(RR09):1-11.

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